Dental Treatment and Lymphedema

Introduction

A cross-section view of a tooth.

Because the human mouth contains a multitude of bacteria, there is always some risk of infection. Neglect of the teeth can cause painful problems such as a dental abscess (infection) or periodontal disease (bleeding gums).

• Treatment of a dental emergency, or even routine preventive dental care such as a prophylaxis (cleaning), can cause bleeding in the mouth.
• This bleeding creates an opening for bacteria to enter the bloodstream. Once in the bloodstream these bacteria tavel and can cause an infection, such as cellulitis, elsewhere in the body including in a lymphedema-affected area.

Currently there is no available research on how great this risk of infection is. Also there are no guidelines from the American Dental Association (ADA) for dental professionals to use when treating patients with lymphedema. Obviously there is a need for more research and the development of these guidelines.*

Dental Infections

X-Ray showing a dental abscess.

For anyone, including those who do not have lymphedema, a dental infection such as the abscessed tooth, is serious infection that needs immediate attention. This often requires the administration of antibiotics. For those with lymphedema, such an infection creates an even greater risk because there is the danger that the infection will spread to the lymphedema-affected tissues.

Prophylactic Antibiotics

In the past some physicians and lymphedema therapists recommended that patients with lymphedema take a prophylactic (preventive) course of antibiotics when having dental treatment; however in 2005 according to Kathleen Francis MD, "At this time there is no specific scientifically supported recommendation for antibiotic proplylaxis for dental procedures in patients with lymphedema." [1]

The exception to this finding arises when a lymphedema patient who is prone to infections and is about to undergo extensive dental surgery. In this situation, the need to prevent an infection needs to be balanced with the danger of over using antibiotics so that they are no longer effective in combating cellulitis.

Therefore before scheduling major dental surgery, you should initiate a discussion with your dentist as to whether or not antibiotics are indicated as a preventive measure. This decision should be based on your personal situation including the following factors.

• The location of your lymphedema and how well controlled it is.
• Your previous history of lymphedema-associated infections and whether or not you currently have open sores.
• The invasive nature of the proposed dental treatment.
• If antibiotics are necessary, your dentist is usually the one who will write the antibiotic prescription; however, a consultation with your physician may also be indicated.

Routine Self-Care

• Brush your teeth regularly using a soft bristle toothbrush and then use an anti-bacterial or antiseptic mouthwash.
• See your dentist regularly for preventive care to reduce the risk of having a dental emergency.
• If your gums bleed regularly when you brush your teeth, and don’t stop after two weeks of brushing with a soft tooth brush, it is time to see your dentist for professional assistance. Bleeding gums are also an indication of periodontal (gum) disease and the bleeding areas are potential opens for bacteria to enter your system.
• If you have a dental infection seek prompt treatment. If you feel your dentist is not taking an infection seriously enough, get medical help.

What Can You Do To Protect Yourself?

• Until there are official guidelines for dentists to use when treating those of us with lymphedema, we need to educate them. We can provide our dentists with information about lymphedema and with guidelines for our own dental care. Dental health is important. Don’t let the risks of treatment scare you away. Ignoring dental health could result in an even riskier situation. Do manage your dental care so that the risks are minimal.
• Talk to your physician or lymphedema therapist about the use of prophylactic antibiotics before major dental dental procedures. If antibiotics are recommended, get this information in writing (a short handwritten note will do) and take this message to your dentist. Check regularly that it is up-to-date.
• Educate your dentist about lymphedema. Make certain ahead of time that your dentist: A) understands your risk of infection; B) is willing to comply with your physician’s/therapist’s recommendations; C) is willing to prescribe antibiotics when appropriate; and D) is willing to treat dental infections as emergencies.
• If you need antibiotics, get the prescription filled several days before your scheduled dental treatment and start taking the medication as directed.
• If you are referred by your dentist to a dental specialist (endodontist, periodontist, etc.) ask that your dentist mention your special needs in his or her message of referral.

Conclusion

Clearly, we would benefit from research and a set of guidelines for dentists. You can help this happen by communicating with the ADA,  your State Dental Association, or nearby dental school to make them aware of the need for research and guidelines to use when providing dental care for those with lymphedema.

Until there are official guidelines to use when treating those of us with lymphedema, we need to educate our dentists and manage our dental care so that the risks are minimal.  We can provide our dentists with information about lymphedema and with guidelines for our own dental care.

* A Special Thank You

This article was written by Mary Pat Boersma who has done volunteer work in health care as a patient advocate for several years.  She was diagnosed last year with chest wall lymphedema, and a year-long adventure in getting a diagnosis, roused her interest in lymphedema patient advocacy.  Her own dental emergency shortly after diagnosis led her to gather as much information she could find on dental care and lymphedema.

Reference

[1] "Question Corner" by Kathleen Francis, MD. published in the NLN Lymph Link, Vol 17, No 4, (October-December 2005) page 26.

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Category: Living With Lymphedema Updated: 2009-11-13